Clinical note quick-picks list

Anesthetic Area

The area for the anesthetic

Select one:

• palate

• facial

• buccal

• lingual

Anesthetic for Tooth

The tooth that the anesthetic was injected adjacent to

Select one:

Anesthetic, Local

The local anesthetic that was injected

Select one:

• Articaine, 4% with Epinephrine 1:100,000

• Articaine, 4% with Epinephrine 1:200,000

• Bupivacaine, 0.5% with Epinephrine 1:200,000

• Carbocaine, 3% plain

• Citanest Forte, 4% with Epinephrine 1:200,000

• Citanest Plain, 4% without Vasoconstrictior

• Duranest, 1.5% with Epinephrine 1:200,000

• Lidocaine, 2% with Epinephrine 1:100,000

• Lidocaine HCL, 2% with Epinephrine 1:100,000

• Lidocaine HCL, 2% with Epinephrine 1:50,000

• Mepivacaine, 2% with Levonordefrin 1:20,000

• Mepivacaine, 3% plain

• Prilocaine, 4% plain

• Prilocaine, 4% with Epinephrine 1:200,000

• Septocaine, 4% with Epinephrine 1:100,000

• Xylocaine, 2% with Epinephrine 1:50,000

• Xylocaine, 2% with Epinephrine 1:100,000

Anesthetic, Needle Gauge

The gauge of the needle that was used

Select one:

• 25

• 27

• 30

Anesthetic, Needle Length

The length of the needle that was used

Select one:

• long

• short

Anesthetic, None Given

The reason that no anesthesia was given

Select one:

• The procedure was minimally invasive

• The patient requested no anesthesia

Anesthetic, Topical

The topical anesthetic that was used

Select one:

• Benzocaine

• Dyclonine hydrocholoride

• Ethocaine

• Lidocaine solution

• Lidocaine ointment

• Lidocaine spray

• Oraqix

• Procaine

• Topicaine anesthetic gel

• Topex anesthetic gel

• Topex anesthetic spray

• Xylocaine

Bonding Agent

The bonding agent that was used

Select one:

• Adper Scotchbond

• Clearfil

• Excite

• Fuji Bond

• OptiBond.

Carpules, Fraction

The fraction of the whole carpules that were injected

Select one:

Carpules, Qty

The whole number of carpules that were injected

Select one:

Cement, Permanent

The cement that was used

Select one:

• Durelon

• Glasionomer

• Panavia

• RelyX

• Variolink II

• Zinc Phosphate

Cement, Temporary

The temporary filling that was used

Select one:

• Cavit

• IRM

• Provolink

• Tempbond

• Temrex

• ZOE

• Zone

Cosmetic Aberration

The cosmetic abberation that the patient has

Select one:

• skeletal aberration

• soft tissue aberration

Cosmetic Aberration Notes

Notes regarding the cosmetic abberation, such as the location

Type text

Cosmetic Aberration Treatable

Whether or not the cosmetic abberation is treatable

Select one:

• treatable by Dentist

• treatable by Physician

• not treatable

Cosmetic Area

The area of the cosmetic issue

Select one:

• maxillary, anterior

• maxillary, posterior

• mandibular, anterior

• mandibular, posterior

Cosmetic Issue

The cosmetic issue that the patient has

Select one:

• abnormal tooth morphology

• diastema

• fractured teeth

• malalignment

• missing teeth

• stains

• unacceptable restorations

Cosmetic Level

The severity of the cosmetic issue

Select one:

• no

• a mild level of

• a moderate level of

• a severe level of

Crown Replacement Reason

The reason for the crown replacement

Select one:

• decay

• fractured porcelain

• other

Crown Type

The type of crown

Select one:

• resin-based composite

• resin with high noble metal

• resin with predominantly base metal

• resin with noble metal

• porcelain ceramic substrate

• porcelain fused to high noble metal

• porcelain fused to predominantly base metal

• porcelain fused to noble metal

• full cast high noble metal

• full cast predominantly base metal

• full cast noble metal

• titanium

• provisional

• previous

Decay Detection Method

The method that the decay was detected by

Select all that apply:

• x-ray

• explorer

• laser fluorescence

• other

Decay Level

The level of existing decay that the patient has

Select one:

• no

• minimal

• moderate

• extensive

Denture Arch

The denture arch

Select one:

• upper

• lower

Exam Type

The clinical exam type

Select one:

• Initial

• Recare

• Emergency

• Other

Eval MA, Lip Habits

Notes regarding the myofunctional analysis that was made of the lip habits

Type text

Eval MA, Speech

Notes regarding the myofunctional analysis that was made of the speech habits

Type text

Eval MA, Tongue Habits

Notes regarding the myofunctional analysis that was made of the tongue habits

Type text

Eval TMJ Diagnosis

The TMJ diagnosis

Select one:

• TMJ Issues Not Present

• TMJ Treatable by Dentist

• TMJ Treatable by Specialist

• TMJ is not Treatable

Eval TMJ, Motion/Deviation

The level of TMJ motion or deviation

Select one:

• None

• Mild

• Moderate

• Severe

Eval TMJ, Subluxation/Crepitus

The level of TMJ subluxation or crepitus

Select one:

• None

• Mild

• Moderate

• Severe

Eval TMJ, Symptoms Report

Notes regarding the TMJ symptoms that the patient reported.

Type text

Habits, Bulemia/Anorexia

The result of the evaluation of signs of bulemia or anorexia

Select one:

• None

• Potential

• Manifested

Habits, Cheek Biting

The result of the evaluation of signs of cheek biting

Select one:

• None

• Potential

• Manifested

Habits, Chewing Tobacco

The result of the evaluation of signs of smokeless tobacco use

Select one:

• None

• Potential

• Manifested

Habits, Cig Smoking

The result of the evaluation of signs of cigarette and/or cigar smoking

Select one:

• None

• Potential

• Manifested

Habits, Gum Chewing

The result of the evaluation of signs of gum chewing

Select one:

• None

• Potential

• Manifested

Habits, Mouth Breathing

The result of the evaluation of signs of mouth breathing

Select one:

• None

• Potential

• Manifested

Habits, Nail Biting

The result of the evaluation of signs of nail biting

Select one:

• None

• Potential

• Manifested

Habits, Other

Notes regarding any other habits that the patient exhibits signs of

Type text

Habits, Pipe Smoking

The result of the evaluation of signs of pipe smoking

Select one:

• None

• Potential

• Manifested

Habits, Substance Abuse

The result of the evaluation of signs of substance abuse

Select one:

• None

• Potential

• Manifested

Habits, Teeth Grind/Clench

The result of the evaluation of signs of teeth grinding and/or clenching

Select one:

• None

• Potential

• Manifested

Habits, Thumb Sucking

The result of the evaluation of signs of thumb and/or finger sucking

Select one:

• None

• Potential

• Manifested

Habits, Tongue Thrusting

The result of the evaluation of signs of tongue thrusting

Select one:

• None

• Potential

• Manifested

Habits, Toothpick Use

The result of the evaluation of signs of toothpick or stimulator use

Select one:

• None

• Potential

• Manifested

Health Issues

The health issues that apply to the patient

Select all that apply:

Occlusion, Aesthetic, Dr.

The perception of the doctor regarding the aesthetics of the occlusion

Select one:

• None

• Good

• Fair

• Poor

Occlusion, Aesthetic, Patient

The perception of the patient regarding the aesthetics of the occlusion

Select one:

• None

• Good

• Fair

• Poor

Occlusion, Appliance Space

Notes regarding the space that is available for appliances

Type text

Occlusion, Arch Length

The result of the examination of the arch length

Select one:

• No issues

• Mild

• Moderate

• Severe

Occlusion, Classification

The classification of the occlusion

Select one:

• Class I

• Class II

• Class III

Occlusion, Crossbite

The result of the examination for crossbite

Select one:

• None

• Anterior

• Posterior

Occlusion, Crowding

The result of the examination for crowding

Select one:

• None

• Mild

• Moderate

• Severe

Occlusion, Function, Dr.

The perception of the doctor regarding the functionality of the occlusion

Select one:

• None

• Good

• Fair

• Poor

Occlusion, Function, Patient

The perception of the doctor regarding the functionality of the occlusion

Select one:

• None

• Good

• Fair

• Poor

Occlusion, Left Lateral

Notes regarding the left lateral side of the occlusion

Type text

Occlusion, Overall Spacing

The result of an examination of the overall spacing

Select one:

• No issues

• Mild

• Moderate

• Severe

Occlusion, Overbite (mm)

The length of the overbite in millimeters

Type text

Occlusion, Overjet (mm)

The length of the overjet in millimeters

Type text

Occlusion, Right Lateral

Notes regarding the right lateral side of the occlusion

Type text

Oral Hygiene, Calculus

Notes regarding the examination of calculus

Type text

Oral Hygiene, Food Impaction

Notes regarding the examination of food impaction

Type text

Oral Hygiene, Overall

The assessment of the overall oral hygiene

Select one:

• Normal

• Excellent

• Poor

Oral Hygiene, Plaque

Notes regarding the examination of plaque

Type text

Oral Hygiene, Stain

Notes regarding the examination of stains on the teeth

Type text

Oral Pathology Level

The severity level of the oral pathology

Select one:

• no

• mild

• moderate

• severe

Oral Pathology Prognosis

The prognosis of the oral pathology

Select one:

• good

• fair

• poor

• unknown

Oral Pathology Treatment

The recommended treament option for the oral pathology

Select one:

• No treatment

• A biopsy

• Other treatment

• Patient referral to a specialist

Oral Pathology Type

The type of oral pathology present

Select one:

• evident

• developmental

• systemic

• surface

• deep

Oral Pathology, Tooth Related

The determination of the oral pathology being tooth related

Select one:

• There is no evident tooth-related oral pathology

• Oral pathology is tooth related

• Oral pathology is not tooth related

Oral Rinse

The oral rinse that was used

Select one:

• ACCLEAN

• Oris CHX

• Peridex

• PerioGard

• Peroxyl

• Rincinol

• Viadent

Ortho Issue

The reason for the orthodontic referral

Select all that apply:

• a crossbite

• an overbite

• an overjet

• tooth crowding

• a diastema

• tooth spacing issues

• multiple orthodontic issues

Pain Area

The area of the pain

Select one:

• facial

• buccal

• palatal

• lingual

Pain Level

The pain level tha was reported by the patient

Select one:

• low acute

• low chronic

• high acute

• high chronic

Pain Manifestation

What there is evidence of regarding the pain

Select one:

• bleeding

• suppuration

• swelling

• ulceration

Patient Dismissal Reason

The reason that the patient was dismissed

Select one:

• non-payment of debt

• excessive missed appointments

• verbal abusiveness to staff

• other

Patient Referred, Reason

The reason for the referral

Select one:

• second opinion

• further treatment

Patient Referred, Specialty

The specialty of the doctor who the patient was referred to

Select one:

• an endodontist

• an orthodontist

• an oral surgeon

• a pedodontist

• a periodontist

• a prosthodontist

• their primary care physician

Patient Response, Sensitivity

Whether or not the patient experiences sensitivity

Select one:

• affirmative

• negative

• undecided

Perio, Attached Gingiva

The result of the examination of the ginigival attachment

Select one:

• Skipped

• Normal

• Recession

• Enlarged Tissue

Perio, Bleeding

The level of gingival bleeding

Select one:

• Skipped

• None

• Mild

• Moderate

• Severe

Perio, Bone Loss Pattern

The bone loss pattern

Select one:

• Skipped

• None

• Horizontal

• Vertical

Perio, Bone Loss Severity

The severity of the bone loss

Select one:

• Skipped

• None

• Mild

• Moderate

• Severe

Perio, Calculus

The level of calculus

Select one:

• Skipped

• None

• Light

• Moderate

• Heavy

Perio, Classification

The periodontal classification

Select one:

• Skipped

• Normal

• I-Gingival Diseases, dental plaque-induced

• I-Gingival Diseases, non-plaque-induced lesions

• II-Chronic Periodontitis, localized, slight severity

• II-Chronic Periodontitis, localized, moderate severity

• II-Chronic Periodontitis, localized, severe;

• II-Chronic Periodontitis, generalized, slight severity

• II-Chronic Periodontitis, generalized, moderate severity

• II-Chronic Periodontitis, generalized, severe

• III-Aggressive Periodontitis, localized, slight severity

• III-Aggressive Periodontitis, localized, moderate severity

• III-Aggressive Periodontitis, localized, severe

• III-Aggressive Periodontitis, generalized, slight severity

• III-Aggressive Periodontitis, generalized, moderate severity

• III-Aggressive Periodontitis, generalized, severe

• IV-Periodontitis as a Manifestation of Systemic Diseases

• V-Necrotizing Periodontal Diseases, ulcerative gingivitis

• V-Necrotizing Periodontal Diseases, ulcerative periodontitis

• VI-Abscesses of the Periodontium, gingival

• VI-Abscesses of the Periodontium, pericoronal

• VII-Periodontitis Associated With Endodontic Lesions

• VIII-Developmental or Acquired Deformities and Conditions

Perio, Color

The color of the gingiva

Select one:

• Skipped

• Normal

• Pale White

• Whitish Pink

• Coral Pink

• Pink

• Red

• Magenta

• Pink with Magenta areas

• Bluish Red

• Deep Red

Perio, Consistency

The consistency of the gingiva

Select one:

• Skipped

• Firm and resilient

• Edematous

• Fibrotic

• Retractable

Perio, Hypersensitivity

The level of dentinal hypersensitivity

Select one:

• Skipped

• None

• Mild

• Moderate

• Severe

Perio, Inflammation

The level of gingival inflammation

Select one:

• Skipped

• None

• Mild

• Moderate

• Severe

Perio, Margins

The result of the examination of the free gingival margins

Select one:

• Skipped

• Normal (Knife Edged)

• Rolled

• Recessions

• Rounded

• Clefts

• Pseudoclefts

• Cuffing

Perio, Miscellaneous

Additional notes regarding the periodontal examination

Type text

Perio, Papillae

The result of the examination of the interdental papillae

Select one:

• Skipped

• Normal

• Pyramidal or pointed

• Bulbous

• Blunted

• Absent

• Cratered

• Scalloped

• Enlarged

Perio, Plaque

The level of plaque

Select one:

• Skipped

• None

• Light

• Moderate

• Heavy

Perio, Stain

Whether or not stain is present

Select one:

• Skipped

• None

• Exogenous

• Endogenous

Perio, Stain Pigment

The description of the pigment of the stain

Select one:

• Skipped

• Intrinsic, brownish red, blush black

• Intrinsic, grayish brown

• Intrinsic, whitish brown, localized

• Intrinsic, whitish brown, generalized

• Intrinsic, yellowish brown

• Extrinsic, brown

• Extrinsic, black-line

• Extrinsic, green

Perio, Sulcus

The result of the examination of the gingival sulcus

Select one:

• Skipped

• None

• Blood

• Exudates

Perio, Suppuration

The level of suppuration

Select one:

• Skipped

• None

• Mild

• Moderate

• Severe

Perio, Texture

The texture of the gingiva surface

Select one:

• Skipped

• Normal

• Stippling

• Shiny and smooth

• Rough

Phosphoric Acid Etchant %

The phosphoric acid etchant percent

Select one:

• 10%

• 25%

• 34%

• 35%

• 36%

• 37%

• 38%

• 40%

• 50%

Post-Op Given

Who the post-op instructions were given to

Select one:

• patient

• patient's parent

• itempatient's guardian/p>

• itempatient's spouse/p>

• other

Post-Op Instructions

How the post-op instructions were given

Select all that apply:

• computer generated

• verbal

• written

Prophy Scaling

The degree of scaling

Select one:

• general

• light

Pulp Test

The reading of the pulp test

Select one:

Quadrant-Select Multiple

The quadrants

Select all that apply:

• Upper Right

• Upper Left

• Lower Right

• Lower Left

Quadrant-Select One

The quadrant

Select one:

• Upper Right

• Upper Left

• Lower Right

• Lower Left

Quadrant-With Pain

The quadrant where the pain is present

Select one:

• Upper Right

• Upper Left

• Lower Right

• Lower Left

Restoration Material

The restoration material

Select one:

• amalgam

• composite

Restorative Issues

Notes regarding any additional restorative issues

Type text

Return Appointment

Select whether or not a return appointment was scheduled

Select one:

• scheduled a return appointment

• refused to schedule a return appointment

Rx Drug Name

The drug name

Select one:

• Amoxicillin 500 mg

• Celcor 500 mg

• Hydrocondone 5 mg

• Keflex 500 mg

• Tylenol #3

• Valium 5 mg

• Zpak

Rx Quantity

The quantity to dispense

Select one:

• 8 tabs

• 20 tabs

• 30 tabs

• dispense one pack

Rx Refills

The number of refills that are allowed

Select one:

Rx Sig - Instructions

The dosing instructions

Select one:

• Take 2 now

• 1 Q 6 H until gone

• 1 Q4-6H pm pain

Rx to Pharmacy

The method that the prescription was given to the pharmacy

Select one:

• phoned in to a pharmacy technician

• phoned in to the pharmacy

• A message was left on the pharmacy's answering machine

• sent to the pharmacy by fax

• sent to the pharmacy by e-mail

Shade #

Type the shade number for the specified shade letter and shade guide

Type text

Shade Guide

The shade guide that was used

Select one:

• Bioblend

• Bioform

• Chromascop

• Portrait

• SR Vivodent PE

• Trublend

• Trubyte

• Vita

• Custom Shade Guide

Shade Letter

The shade letter

Select one:

• A

• B

• C

• D

• Custom Shade Letter

Size of Ulcer

The size of the ulcer

Select one:

• less than 5 mm

• 5 mm to 10 mm

• greater than 1 cm

Sextant-Select Multiple

The sextants

Select sextant(s):

• Upper Right

• Upper Anterior

• Upper Left

• Lower Right

• Lower Anterior

• Lower Left

Sextant-Select One

The sextant

Select sextant:

• Upper Right

• Upper Anterior

• Upper Left

• Lower Right

• Lower Anterior

• Lower Left

STE Extraoral Head/Neck

Notes regarding the soft-tissue examination of the head and neck

Type text

STE Floor of Mouth

Notes regarding the soft-tissue examination of the floor of the mouth

Type text

STE Labial/Buccal Mucosa

Notes regarding the soft-tissue examination of the labial or buccal mucosa

Type text

STE Lips

Notes regarding the soft-tissue examination of the lips

Type text

STE Lymph Chain

Notes regarding the soft-tissue examination of the lymph chain

Type text

STE Palate, Hard/Soft

Notes regarding the soft-tissue examination of the hard or soft palate

Type text

STE Pharynx

Notes regarding the soft-tissue examination of the pharynx

Type text

STE Tongue

Notes regarding the soft-tissue examination of the tongue

Type text

Surface-Select

The surfaces

Select all that apply:

• mesial

• incisal

• occlusal

• distal

• lingual

• lingual, class five

• facial

• facial, class five

• buccal

• buccal, class five

Surface-Select Text

The surface

Select one:

• mesial

• incisal

• occlusal

• distal

• lingual

• facial

• buccal

• mesiobuccal

• mesiolingual

• distobuccal

• distolingual

Surfaces Covered-Old

The surfaces that were covered by the old restoration

Select all that apply:

• mesial

• incisal

• occlusal

• distal

• lingual

• lingual, class five

• facial

• facial, class five

• buccal

• buccal, class five

Temperature

What the patient has sensitivity to

Select one:

• heat

• cold

• heat and cold

TMJ Joints

The TMJ

Select one:

• Right TMJ

• Left TMJ

Tooth-Missing

The tooth that is missing

Select one:

Tooth-Receiving Treatment

The tooth that is receiving treatment

Select one:

Tooth-Select Multiple

The teeth

Select all that apply:

Tooth-Select One

The tooth

Select one:

Tooth-With Pain

The tooth that is causing the patient pain

Select one:

Tx Plan

The recommended treatment option

Select one:

• amalgam surface restoration

• a composite surface restoration

• an extraction

• an apicoectomy

• a root canal

• a post and core

• a crown

• a bridge

• a partial denture

• a full denture

• an implant

• a referral to a specialist

Tx Plan, Bridge/Crown

Whether the recommended treatment is for a bridge or a crown

Select one:

• bridge

• crown

Tx Plan, Ready for Crown

The treatment that was performed to make the tooth ready for a crown

Select one:

• root canal

• root canal and post and core placed